Orthotic device for treating contractures due immobility

ABSTRACT

An orthotic device is disclosed which is useful for extending the range of angular movement between adjacent first and second skeletal body parts which are and have been drawn to and involuntarily held in an immobile angular position relative to one another by contraction of muscles and connective tissue due to immobility. The orthotic device comprises first and second orthotic device portions which are interconnected for permitting pivotal angular motion therebetween for establishing an initial angle therebetween. The device is constructed for operatively applying or detachably attaching the first orthotic device portion to the first body part and the second orthotic device portion to the second body part after the second body part has been pivoted by an externally-applied force to an increased angular position relative to the first body part, the first and second orthotic device portions being then an initial angular position relative to one another which corresponds to the increased angular position of the second body part. A spring is connected between the first and second orthotic device portions for urging the second orthotic device portion to return to its initial angular position relative to the first orthotic device portion when the second orthotic device portion is pulled by the applied first body part through muscular contraction and/or the elastic properties of the muscles and connective tissue from the increased angular position toward the first angular position of the second body part relative to the first body part. The orthotic device may be configured for use with an arm, leg, ankle, head, back and other skeletal body parts.

This application is a divisional application of application Ser. No.08/827,604, filed Mar. 28, 1997, now U.S. Pat. No. 5,891,068.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates generally to the field of orthotic devicesand appliances; more particularly to orthotic devices and appliancesuseful for restoring movement to a connective joint of a mammalian body;and still more particularly to orthotic devices and appliances used toreverse contractures due to immobility and neurological dysfunction.

2. Background Discussion

Webster's New Collegiate Dictionary defines "orthotics" as "a branch ofmechanical and medical science that deals with the support and bracingof weak or ineffective joints or muscles."

Orthotic devices and appliances, commonly referred to just as"orthotics" (in spite of the broader dictionary definition of orthotics)have been utilized for many years by physical therapists, occupationaltherapists, and certified orthotic fitters to assist in therehabilitation of loss of range of motion (LROM) of patients' joints andassociated limbs or adjacent skeletal parts of the patients' body.

Orthotics, as well as splints, have been designed both to maintain andto restore the range of bodily motion due to LROM. Such loss of range ofmotion may, for example, be caused by traumatic injury, rehabilitationfollowing joint or limb surgery, and contracture due to immobilizationcaused by neuromuscular disorders (e.g., stoke and closed head injury)and other disease processes that significantly limit a patients abilityto use a joint for normal activities of daily living (ADL).

Two fundamentally different types of contractures exist which clinicallyshould have two different treatment protocols. The difference in thesetwo types of contractures is the basis for the clinical techniques anddesign of the orthotics of the present invention which will be describedbelow.

A first one of these two fundamentally different types of contracturemay be defined as a fixed, high resistance of muscle to passive stretchresulting from fibrosis of the muscles and joints, or from disorders ofthe muscle fiber resulting in LROM, for example, of a patient's arm orleg. In this regard, Webster's Dictionary defines "contracture" as "apermanent shortening (as of muscle, tendon and scar tissue) producingdeformity or distortion."

This first type of contracture is usually due to trauma, injury, orsurgical intervention affecting the joint, as may be typical of sportsinjuries and the treatment thereof. As the injured tissue heals, edema,post trauma or surgically affected tissue regeneration and other naturalhealing processes result in fusing together of what were, prior to thetrauma, separate, pristine connective tissues, that is, the collagenfiber matrix (depicted diagrammatically in FIG. 1A hereof), capable ofeasily gliding over one another, as is needed for normal joint movementand related muscle elongation.

However, post-trauma, this collagen fiber matrix becomes random andirregular (depicted diagrammatically in FIG. 1B hereof), and neitherelongates nor stretches compared to non-traumatized collagen fibers.This fusing-together or adhesion of connective tissue structures (e.g.,ligaments, tendons, synovial membrane, fascia and fibrous jointcapsules) is the result of the tissues being invaded by developingundifferentiated scar between adjacent tissue, thereby diminishing orpreventing the mutual gliding after early healing of the trauma orpost-surgical trauma has been accomplished.

Such fusing together of connective tissue is a leading cause of lags (anon-specific indictment of the motor system's failure to move theaffected joint through the full available passive range) relating totendon gliding, depending on their strategic placement in reference tostructures crossing the joint. With limited mobility and associatedextensor muscle atrophy, combined with the formation of adhesions andscar tissue in the form of a significantly increased number of joinedfiber matrix junctions, the muscle fibers become shortened.

The restoration of full range of motion where fibrosis of the musclefiber with scar tissue and adhesions are present, requires that theadhesions and scar tissue or fused fiber matrix junctions be "workedthrough" or broken to restore normal functional elongation or stretch.The term "no pain, no gain" (of increased ROM) is associated with theprocess of breaking through joined or fused fiber matrix junctions torestore full elongation of the connective tissue, tendons and musclesassociated with the trauma-affected joint.

Heretofore known orthotics are primarily designed to treat this firsttype of contracture, but have also been used to treat contracturescaused by immobility and neurological dysfunction (described below).However, such orthotic devices are not, as far as is known by thepresent inventor, best suited for such additional purpose.

The second and very different type of contracture results from jointimmobility--not joint-related trauma or surgical repair of a joint.Contracture resulting from immobility is simply a shortening andthickening of the connective tissue, tendons and muscles (depicted inFIG. 1C hereof) that restrict the ROM of a joint. In such situations,the muscle fibers still retain their original uniform shape and thereare no adhesions or scar tissue or significantly increased joined fibermatrix junctions to break through in order to restore full range ofmotion.

In contrast to trauma-caused contractures, contractures due toimmobility do not need a "no pain, no gain" approach to restoring thenormal range of motion, and, in fact, such an approach can actually domore harm than good. As mentioned above, the collagen fibers of acontracture due to immobility are simply shorter and thicker, and willrespond to appropriate stretching techniques and motion of the joint torestore LROM. The stretching technique usually used for contracturescaused by immobility is Range Of Motion (ROM) Therapy and the use ofLow-Load Protracted Stretch/Stress (LLPS) or "extended stretch" staticor dynamic orthotic devices.

According to authors Kenneth R. Flowers and Susan L. Michlovitz in theirarticle titled "ASSESSMENT AND MANAGEMENT OF LOSS OF MOTION INORTHOPEDIC DYSFUNCTION" (published in Postgraduate Advances in PHYSICALTHERAPY, American Physical Therapy Association, 1988 II-VIII), Total EndRange Time (TERT) in conjunction with LLPS is the key to restoring fullROM.

All contractures, whether caused by injury, surgery, or immobility,limit range of motion of the affected joint and make simple activitiesof daily living, such as eating and self-dressing, more difficult, ifnot impossible. Moderate to severe contractures can be debilitating, andcan leave afflicted individuals bed-bound and unable to care forthemselves in the most basic daily living tasks. Even mild contracturesdue to immobility can progress to severe contractures if properintervention is not prescribed and implemented so long as the immobilitycontinues.

A principal objective of my current invention is accordingly to providemore clinically effective orthotics that are an alternative to the knowntypes of orthotics currently used to treat contractures caused byimmobility and the ROM stretching technique. The main function of my newand more effective orthotic devices is to treat contracture due toimmobility--not trauma related to surgery or injury.

The present inventor considers that TERT with Activity Stimulus strategy(i.e., flexing)--not LLPS--is the key to predisposing tissue toelongation and restoring range of motion, where LROM is due toimmobility or neurological dysfunction.

The clinical importance and value of my invention are significant inthat contractures and other hazards of immobility are one of the tencurrent highest health care costs in America that are totallypreventable. This puts the health risks associated with immobility inthe same category as cigarette smoking, alcohol and drug abuse, andautomobile accidents in financial impact on American health care costs.

The new orthotic devices of the present invention provide more effectiveclinical treatment for LROM due to immobility by increasing the"stimulus of activity" of the affected tissue (connective and musclefiber) rather than just holding the issue in moderately lengthenedposition (LLPS or "gradual extension" therapy). According to Brand(1984), "It is better not to use the word stretch for what should belong-term growth. If we want to restore normal length to a tissue thathas shortened after disease (or disuse), we need to reverse the processand apply the stimulus of activity, or better, the stimulus of holdingthe tissue in the moderately lengthened position for a significanttime." According to Brand, it will then "grow" or lengthen. Flowers andMichovitz in the before-mentioned article theorize that the jointsomehow senses or computes the total stress applied to it in any givendirection over a period of time. It then stimulates a proportionateamount of biological activity, leading to a proportionate mount ofremodeling of the stressed tissue. The total stress is a product of itsintensity, frequency and duration. The crucial elements in thisconceptual model are frequency and duration. Total stress equalsintensity times frequency times duration (intensity×frequency×duration).

The present orthotic devices increase the stimulus of activity relativeto current orthotic devices which simply hold the limb and joint in anextended position for extended periods. Conceptually, patient outcomesshould be more positive based upon an increased stimulus of activity aswell as providing moderate stretch for a prolonged period with the newdevices. The cycling or repeated extension and contraction of the jointby the new devices provides the additional benefits of motion(activity), increased lubrication of the tissues (production of synovialfluid) facilitating movement, and muscle re-education and diminishedspasticity where neurological dysfunction is present (stroke, closedhead injury, MS, etc.). The level of activity is higher with the newdevices when high tone, spasticity, or moderate to high contractionreflexes are present in the affected limb and joint. Thus the newdevices are uniquely appropriate for contractures due to immobilitywhere neurological dysfunction is present in the affected limb.

SUMMARY OF THE INVENTION

In accordance with the present invention, there are provided orthoticdevices useful for extending the range of angular movement betweenadjacent first and second skeletal body parts which are have been drawnto and involuntarily held in a shortened or restricted angular position(limited to a narrow range of motion) relative to one another bycontraction of muscles and connective tissue due to immobility. Eachsuch orthotic device comprises a first orthotic device portion, a secondorthotic device portion, and means interconnecting the first and secondorthotic device portions for permitting relative angular motiontherebetween. Included are means for establishing an initial anglebetween the first and second orthotic device portions.

Further comprising the orthotic device are means for operativelyapplying or connecting the first orthotic device portion to the firstbody part and the second orthotic device portion to the second body partafter the second body part has been pivoted, by an externally-appliedforce, to an increased angular position relative to the first body part,the first and first orthotic device portions being then set by theestablishing means at the initial angular position relative to oneanother which corresponds to the increased angular position of thesecond body part relative to the first body part.

Spring means are connected between the first and second orthotic deviceportions for urging the second orthotic device portion to return to itsinitial angular position relative to the first orthotic device portionwhen the second orthotic device portion is pulled by the applied firstbody part through muscular contraction and/or the elastic properties ofthe muscles and connective tissue from the increased angular positiontoward the first angular position of the second body part relative tothe first body part, thereby pulling the second body part back towardthe increased angular position relative to the first body part.

The spring means are configured so that pivotal movement of the secondorthotic device portion relative to the first orthotic device portionaway from the increased angular position causes a restoring loading ofthe spring means. This restoring loading of the spring means and themuscular contraction and/or the elastic properties of the muscles andconnective tissue of the first body part act against one another andcause the second body part to cycle angularly toward and away from thefirst angular position and the increased angular position withoutfurther external intervention, thereby causing a gradual angularloosening of the first body part relative to the first body part andultimately positioning the second body part at the increased angularposition without the application of other forces.

The spring means are further configured for providing substantially nospring force between the first and second orthotic device portions whenthe second orthotic device portion is at the initial angular positionrelative to the first orthotic device portion.

In one embodiment of the invention, the first body part comprises theindividual's upper limb part and wherein the second body part comprisesthe individual's lower limb part, the limb being the individual's arm orleg.

In such case, the first orthotic device portion includes a first cuffand the second orthotic device portion includes a second cuff. Theapplying means releasably attaches the first cuff to the upper limb partand releasably attaches the second cuff to the individual's lower limbpart.

The interconnecting means comprise at least one stiff member having afirst end region fixed to the first cuff and a second end region fixedto the second cuff and including a hinge intermediate the first andsecond end regions for enabling relative angular movement therebetweenin a plane defined by the longitudinal axis of the limb upper and lowerparts.

Means are included for releasably locking the hinge at any selectedangular position of the first end region relative to the second endregion. The hinge may also or alternatively include a ratchet forenabling the opening of the first end region relative to the second endregion from one angle therebetween to a larger angle therebetween.

Preferably, the spring means comprise relative outwardly bowing andtwisting of the first and second end regions of the member when thesecond end region of the bar is pivoted from the initial angularposition relative to the second end region to a smaller angletherebetween.

In a variation orthotic device, the orthotic device of the presentinvention comprises a thermal setting, flexible member having first andsecond regions defined by a bend line between the first and secondmember regions, a bend at the bend line being set by heating, bendingand cooling the member at the bend line, the bend line permittingangular movement and enabling the setting of a selected angle betweenthe first and second member regions.

Means are included applying or attaching the first member region to thefirst body part and the second orthotic device portion to the secondbody part after the second body part has been moved against contractureforces away from the LROM position to an initial extended range ofmotion (ROM) angular position relative to the first body part, the firstand second member regions being then set at the initial extended rangeof motion position relative to one another.

Also includes are spring means associated with the first and secondmember regions for urging the second member region to return to theextended ROM position in response to the second member region beingpulled by the applied or attached first body part through muscle fibercontraction and/or the elastic properties of the muscle fibers andconnective tissue away from the extended ROM position and toward saidLROM position, thereby causing a cycling movement of the second bodypart between said extended ROM and LROM angular positions and a gradualloosening of the second body part relative to the first body part and anultimate extending of the ROM of the second body part relative to thefirst body part at the extended ROM position without additional externalintervention.

The spring means are configured for providing substantially no springforce between the first and second orthotic device portions when thesecond orthotic device portion is at the initial extended ROM angularposition relative to the first member region.

In one version, the first body part comprises the individual's forearmat the wrist and the second body part comprises said individual's hand.In another version, the second body part comprises the individual'slower leg at the ankle and the second body part comprises saidindividual's foot.

In another version, the first body part comprises the individual's backat the neck and the second body part comprises the individual's head. Inanother version, the second body part comprises an upper region theindividual's back and the second body part comprises a lower region ofthe individual's back.

In still another version, the first body part comprises an individual'supper thigh after lower regions of the leg have been amputated and thesecond body part comprises a lower region of the individual's torso atthe hip.

In yet another version, the body part comprises the individual's forearmat the wrist and the second body part comprises said individual's hand.

In the orthotic device for each of the pairs of body parts it ispreferred that the spring means are provided by flexibility of theelastic member.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention may be more readily understood when taken inconjunction with the accompanying drawings in which:

FIG. 1 is a pictorial diagram depicting, in diagrammatic form, thecondition of typical muscle and connective tissue across a joint: FIG.1A depicting the normal condition of a typical bundle or matrix ofnormal muscle and connective tissue fibers; FIG. 1B depicting the samebundle of matrix of muscle and associated connective tissue in a tangledcondition associated with post-trauma conditions and showing adhesion ofthe muscle and connective tissue fibers; and FIG. 1C depicting the samebundle of muscle and connective tissue fibers similar to normal muscleand connective tissue, but having become shortened as a result ofimmobility;

FIG. 2 is a pictorial drawing of an upper region of an individual,showing in solid lines, by way of illustrative example, the individual'sarm involuntarily held in a bent position with the forearm at a highLROM angle, α₀, with respect to the upper arm, and further showing, inphantom lines, the forearm extended at increasing angles α₁ through α₄relative to the upper arm by application of the present orthoticsinvention;

FIG. 3 is a illustrative graph in which forearm angles α₀ through α₄ ofFIG. 2 are plotted against representative intervals of treatment time,depicting several exercise cycles of the individual's arm by use of thepresent orthotic invention to increase the bend or ROM angle between theforearm and the upper arm from α₀ to α₁ in time interval t₀ to t₁, fromα₁ to α₂ in time interval t₁ to t₂, from α₂ to α₃ in time interval t₂ tot₃, and from α₃ to α₄ in time interval t₃ to t₄ ;

FIG. 4 is a partially exploded, perspective drawing of a representativeelbow orthotic device of the present invention which is constructed forproviding gradual extension of a human arm about an elbow joint from aninitial, involuntary tight angle α₀ to an extended angle α₄ whichenables the individual to restore full or partial ROM of his or her arm;

FIG. 5 is a side view of the representative elbow orthotic device ofFIG. 4, showing the device operationally installed onto the individual'sarm in a manner bridging the individual's elbow, with the upper andlower arm held at an initial stretched ROM angle α₁ (referring to FIGS.2 and 3);

FIG. 6 is a longitudinal cross sectional view taken along line 6--6 ofFIG. 5, showing upper and lower arm cuffs of the elbow orthotic device,and showing construction of an associated pair of interconnecting hingedelements which also function as orthotic device return springs;

FIG. 7 is a side view of the elbow orthotic device of FIG. 4 showing thedevice operationally installed onto the individual's arm with the upperand lower arm returned to initial ROM angle α₀ (referring to FIGS. 2 and3) showing flexure of the hinged interconnecting elements;

FIG. 8 is a longitudinal cross sectional view taken line 8--8 of FIG. 5,showing the pair of hinged interconnecting elements flexed and twistedoutwardly at the hinge point in a manner providing a torsion springforce to urge the return of the orthotic device and the wearer's arm tothe initial open position of angle α₁ ;

FIG. 9 is a transverse cross sectional drawing taken along line 9--9 ofFIG. 5, showing the manner in which an upper end region of the orthoticdevice is releasably attached to the individual's upper arm;

FIG. 10 is perspective drawing of a representative one of the hingedinterconnecting members, showing the first and second end portionsdisassembled at the hinge and showing the manner in which the hingeholds the two end portions in a fixed relative position;

FIG. 11 is a perspective drawing of an alternative lockable hingeconnection between second and second device portions of a hingedinterconnecting member, showing a ratchet configuration of the hingeconnection which permits easier and more rapid extension between the twoportions;

FIG. 12 is a perspective drawing of a leg- or knee-type orthotic deviceaccording to the present invention, showing features of the device andshowing the device operatively installed on an individual's knee;

FIG. 13 is a perspective drawing of a hip abductor-type orthotic devicein accordance with the present invention showing useful in treating hipcontracture which limits the range of motion of one leg of an individualrelative to the other leg of the individual, that is, when the leg ismaintained by contracture crossed over the other leg;

FIG. 14 is a perspective drawing of an orthotic device in accordancewith the present invention for the therapeutic treatment of contractureof a representative portion (stump) of an upper leg after the amputationof the remaining, lower portion of the leg, showing a substantially flatthermal-setting, plastic member having a first portion to be weighteddown by the individual's buttocks and a second portion for detachableattachment to the stump;

FIG. 15 is a longitudinal cross sectional drawing taken along line15--15 of FIG. 14 showing the manner in which the second portion of thedevice is manually bent (by heating of the device) in steps from aninitial treatment ROM angle α₁ to an extended ROM angle α₄ ;

FIG. 16 is a perspective drawing of a foot-type orthotic device inaccordance with the present invention for treating contracture of a footwith the toe pointing inwardly and showing construction of the device,including boot and bar portions and showing the boot attached to anindividual's foot;

FIG. 17 is a perspective drawing of a first neck/head positioning-typeorthotic device in accordance with the present invention for treatingcontracture of the cervical region of the spine (neck)with the head in aforward and downward direction by contracture of neck muscle fibers andconnective tissue showing an elongated neck plate having attached toupper regions thereof a headband for detachably attaching to anindividual's head and further showing an upper torso encircling memberfor retaining lower regions of the neck plate;

FIG. 18 is a perspective drawing of a back-type orthotic device inaccordance with the present invention for treating a non-functionalfunctional (forward, backward, S-shaped curvature of an individual'sspine and showing a back plate and upper and lower regions of an uppertorso harness for detachably attaching corresponding upper and lowerregions of the device to an individual;

FIG. 19 is a perspective drawing of an upper torsotype orthotic devicein accordance with the present invention for treating contracture of anindividual's upper body in which the upper body is bent forward or toone side and showing construction of the device and showing means fordetachable attaching the device to an individual's upper body;

FIG. 20 is a perspective drawing of an ankle-type orthotic device inaccordance with the present invention for treating contracture of anindividuals foot relative to his or her ankle in which the toe portionof the foot is held by contracture substantially straight down withrespect to the ankle and showing construction of a boot shaped assembleand means for holding a sole of the boot against the toe portion of thefoot;

FIG. 21 is a perspective drawing of a wrist-hand-finger-type orthoticdevice in accordance with the present invention showing the manner inwhich the device is constructed and detachably attached to anindividual's wrist for treating contracture of an individual's handrelative to his or her wrist, and showing how the device may be used fortreatment of contracture of the individual's fingers relative to his orher hand;

FIG. 22 is a perspective drawing of the wrist-handfinger-type orthoticdevice depicted in FIG. 14, showing the manner in which the device isused for treating contracture of the individual's hand relative to hisor her wrist and also showing how the device may be used for treatmentof contracture of the individual's fingers relative to his or her hand,and further showing the manner in which graduated small-to-large fingerrolls can be attached to the orthotic device for treatment ofcontracture of the fingers;

FIG. 23 is a side view of a head back type of orthotic device inaccordance with the present invention for treating contracture of anindividual's neck in a backwardly bent LROM angular contractureposition, showing an upwardly-extending back member, means fordetachably attaching lower regions of the back plate to an individual'supper body and a elastomeric neck cylinder disposed between upperregions of the back plate and the back of the individual's neck justbelow the individual's head;

FIG. 24 is a perspective drawing showing a series of neck cylinders ofgraduated diameter useful in the head backward orthotic device of FIG.23 (and which are representative of the finger rolls used in thehand-type orthotic device of FIG. 22);

FIG. 25 is a perspective drawing of a shoulder-type orthotic devicefurther in accordance with the present invention for treating acontracture of an individual's arm relative to the individual's upperbody in which the upper arm has a LROM relative to the upper body,showing construction of the device having a pocket for receiving andholding various sizes of elastomeric blocks for causingprogressively-increasing ROM of the arm; and

FIG. 26 is a perspective drawing of the shoulder-type orthotic device ofFIG. 25 showing the manner in which the device is detachably attached tothe individual's upper arm.

In the various Figures identical elements and features are given thesame reference number, and similar or corresponding elements andfeatures are or may be given the same reference numbers followed by ana, b, c, and so on, as appropriate and as will be evident, for purposesof describing the various orthotic devices of the present orthoticdevice invention.

DESCRIPTION OF THE PREFERRED EMBODIMENT

The present inventor suggests that a better understanding of the presentorthotic device invention may be had by a more detailed consideration ofFIGS. 1-3 which depict the operative aspects of the present invention.It is thus believed that a brief consideration of how and why theorthotic devices of the present invention work will lead to anunderstanding of the orthotic devices which are described below.

As briefly mentioned above, FIG. 1 depicts--by way of an illustrativeexample for descriptive purposes, with no limitation being therebyintended or implied--a simplified diagram of a representative bundle ormatrix of muscle fibers and connective tissue which may control ROM oftypical joint, for example, an elbow of a human being.

FIG. 1A depicts a representative bundle or matrix 100 of muscle andconnective tissue in a normal state or condition. FIG. 1B depicts asimilar, representative bundle 102 of muscle fibers and connectivetissue in a twisted and distorted, post-trauma state or condition. Inturn, FIG. 1C depicts a similar, representative bundle 104 of musclefibers and connective tissue in a shortened, but non-distorted state orcondition as a result of immobility.

The present invention, as described below, is designed and constructedto provide treatment for muscles and connective tissue on various partsof the human body skeletal system which are in the condition of bundleof muscle fibers and connective tissue depicted in FIG. 1C as a resultof immobility.

An individual's arm and elbow will be hereinafter be considered for theexpress purposes of describing the present orthotic device invention. Itis, however, to be understood that what is described for the arm, andparticularly for the elbow, applies in principle to such other skeletalparts of the body as the leg, hip, ankle, wrist, hand, neck and back,which may also suffer limited ROM as a result of immobility, and toorthotic devices therefor in accordance with the present invention.

There is depicted in FIG. 2, for such illustrative purposes, and with nolimitation intended or implied, an individual 110 (only the upper torsoof which is shown), is depicted having a right arm or limb 112 whichcomprises an upper arm or upper limb portion 114 and a forearm or lowerlimb portion 116. Forearm 116 is shown in solid lines in an involuntary,slightly extended ROM angular position, α₀, relative to upper arm 114,by contracted muscle and/or interconnecting tissue of the configurationdepicted in FIG. 1C and caused by immobility for a protracted period oftime due to one or more of the above-mentioned causes. Consequently, theafflicted individual 110 is unable by himself or herself to extendforearm 116 from this α₀ position without significant resistance andpotential further injury to the afflicted joint (i.e., elbow).

Depicted in phantom lines in FIG. 2, is a sequence of increasinglygreater angular ROM positions of forearm 116 relative to upper arm 114,these positions being identified for descriptive purposes by ROM anglesα₁, α₂, α₃ and α₄. As will become evident from the followingdescription, these increasing ROM angles α₁, α₂, α₃ and α₄ representincreasingly greater angular ROMs of forearm 116 relative to upper arm114 which result from the application to arm 112 of an elbow-typeorthotic device in accordance with the present invention.

FIG. 3 depicts in a simplified representation the manner in which theincreasing angular ROM of arm 112 as depicted in FIG. 2 may be achievedby use of the present orthotic device invention. As such, FIG. 3 plotsangular ROMs of forearm 116 α₀, α₁, α₂, α₃ and α₄ against representativeperiods of time, in which initial time t₀ corresponds to ROM angle α₀,time t₁ corresponds to increased ROM angle α₁, time t₂ corresponds tofurther increased ROM angle α₂, time t₃ corresponds to still furtherincreases angle α₃, and time t₄ corresponds to full extension ROM angleα₄.

It is to be clearly understood that although the sequential time periodsor intervals to t₀ to t₁, t₁ to t₂, t₂ to t₃ and t₃ to t₄ are depictedin FIG. 3 for illustrative purposes only, as being equal, in practice,the actual time intervals will usually be different, and, in fact, maybe significantly or greatly different.

The objective of FIG. 3 is to depict the general situation in which theincreased ROM of the individual's forearm 116 relative to upper arm 114from α₀ to α₁, over some time interval t₀ to t₁, is gradually achievedthrough a series of forearm arm extension and contraction cycles,identified by the reference number 120. Initial extension of forearm 116to ROM angular position α₁ depicted by initial portion 120a of cycles120, is caused by manual massage and slow extension of the forearm 116to the point of resistance to passive stetch.

When angular position α₁, of forearm 116 is reached through such manualmanipulation, the elbow orthotic device (described below) of the presentinvention is applied to arm 112 and the forearm is released. Thereafterthe angular cycling of forearm 116 relative to upper arm 114 is causedby the counter action of contracture of the individual's muscle and/orconnecting tissue across the elbow, which tend to pull the forearm backtoward its initial shortened involuntary ROM angle α₀ relative to theupper arm, and the restoring spring force of the present orthoticdevice, which operates to pull or extend the forearm back to theextended ROM angle α₁, relative to upper arm 114.

At time t₁, depicted in FIG. 3, and after a number of retraction andextension cycles as described above, the angular ROM of forearm 116relative to upper arm 114 has been increased to ROM angle α₁ such thatindividual 110 will be able to move his or her arm 112 to this extendedROM angular position without mechanical or other assistance. It is,however, to be appreciated that some reinforcement treatment may fromtime to time be required to maintain this increased angular ROM.

It is again emphasized that the extension-retraction cycles in sequence120, although shown regular in nature for illustrative and descriptivepurposes, will, in practice, likely vary in number, length of time andmagnitude, depending upon such factors as condition of the associatedmuscular and connective tissue (hypertonicity, spasticity, contractionreflexes, etc.) length of the immobility time, and age and generalhealth of the patient

At time t₁, when the angular ROM of the individual's forearm 116 hasbeen increased to α₁, the orthotic device is loosened or removed fromarm 112 and the forearm is manually massaged and slowly stretched to anincreased ROM angle α₂. The orthotic device of the present invention isretightened or reapplied to arm and is reset to angle α₂. Forearm 116 isreleased and cycles through a sequence 122 of angular contraction andextension movement in the manner just described for increasing theangular ROM of the forearm to α₁ until the angular ROM of forearm 116 isincreased to angle α₂.

This procedure is repeated through a sequence of contraction andextension cycles 124 to increase the angular ROM of forearm 116 relativeto upper arm 114 from α₂ to angle α₃, and finally through a sequence 126of contraction and extension cycles of forearm movement until a full ROMof the forearm, depicted by angle α₄ has been achieved.

It is, of course, to be understand that more or less that the fourangular extension steps depicted in FIG. 3 may be required in actualpractice and may vary considerably from individual to individual. Inaddition, the sequence of steps achieving ROM increase from its initialLROM angle α₀ to the full range of motion associated with α₄ may requirehours, days, weeks or even months, according to the length of timeforearm 116 has been contracted and the condition (hypertonicity, tone,spasicity, contraction reflexes, etc,) of the muscles and connectivetissue and fibers associated with movement of the forearm.

Elbow- or Arm-Type Orthotic Device of FIGS. 4-11

By way of continuing the illustrative example started above, FIG. 4shows in exploded form a elbow- or arm-type orthotic device 140 inaccordance with the present invention. Elbow-type orthotic device 140will be described in detail as an introduction to other types ofsimilarly functioning orthotic devices included in the present inventionand which will be described hereinbelow.

Elbow-type orthotic device 140 is specifically configured for treatingcontracture of arm 112 relative to elbow 142 and thereby to achieve theextended angular ROM depicted in FIGS. 2 and 3.

As shown in FIG. 4, elbow-type orthotic device 140 comprises generally astiff U-shaped second orthotic device upper arm portion or member 144and a similar, stiff U-shaped second orthotic device lower arm portionor member 146. First and second device portions 144 and 146 areconnected together in a manner enabling relative angular motiontherebetween and are, in fact, hinged together by connecting means 148,as more particularly described below.

Further included in elbow-type orthotic device 140 are a first, upperarm padded cuff 150 and a similar, second, lower arm padded cuff 152.Means for detachably attaching device 140 to arm 112 comprise anadjustable upper strap 154 that is attached to device upper member 144and an adjustable lower strap 156 that is attached to device lowermember 146.

The means 148 for interconnecting upper and lower portions 144 and 146comprise elongate second, right side and second, left side mirror-imageconnecting assemblies 160 and 162, respectively. As shown in FIGS. 4, 6,8 and 10, right side connecting assembly 160 comprises similar upper andlower elements 166 and 168, respectively.

Adjacent ends of elements 166 and 168 are connected for relative angularmovement therebetween by a lockable hinge 170. In the same manner, leftside connecting assembly 162 comprises corresponding upper and lowerelements 174 and 176, respectively, adjacent ends of which are connectedfor relative angular movement therebetween by a lockable hinge 178.

As shown in disassembled condition in FIG. 10, right-hand lockable hinge170 includes mating first and second toothed end regions 180 and 182 ofrespective elements 166 and 168. When assembled and tightened together abolt 184 and nut 186, end regions 180 and 182 intermesh to lock upperand lower elements 166 and 168 in any selected relative angularposition. A left lockable hinge 178, is constructed in the same way, notspecifically shown.

In the alternative connection configuration depicted in FIG. 11, acorresponding right-hand hinge 170a between respective upper and lowerelements 166a and 168a has first and second mating regions 180a and 182ahaving teeth shaped for enabling a ramping or ratcheting action for easyopening of the upper and lower elements to greater angles therebetween,while inhibiting the closing of the elements. Upper and lower elements166a and 168a are fastened together by a bolt 184 and nut 168. Aspring-type washer, for example, a Belleville washer, 188 is installedon bolt 184 so that lower element 168 can be ratcheted to a greaterangle position relative to upper element 166 without completelywithdrawing bolt 184 from nut 186.

As depicted in FIG. 7 for right side connection assembly 160 (typicalalso for left side connection assembly 162) the upper end region ofupper element 166 is non-pivotally attached to a right-hand side regionof device upper member 144, for example, by two rivets, screws or thelike 190. A lower end region of lower element 168 is pivotally attachedto a right-hand side region of device lower member 146 by a single pivotpin or screw 192.

Upper and lower left hand elements 174 and 176 of connection assembly162 are attached to generally opposite sides of respective upper andlower device members 144 and 146 in the manner described for connectionassembly 160.

As shown in FIG. 9, upper elements 166 and 174 are attached to oppositeside regions of upper portion 144 in off-center positions. Assumingarrow A points to a 12 o'clock position of upper member 144, elements166 and 174 are attached to the upper member at about 4 o'clock andabout 8 o'clock positions, respectively. The attachment of lowerelements 168 and 176 are attached to lower member 146 in a similarlyoffset manner. Such offset attachments enable appropriate spring actionof connecting assemblies 160 and 162, as described below.

Upper and lower elements 166 and 168 of right connecting assembly 160are constructed, as shown in FIG. 6, which represents orthotic device140 in the unloaded or initially set angular position α₁ of device 140,as being slightly bowed outwardly in the region of hinge 170 from acentral longitudinal axis 200. In a similar manner, elements 174 and 176of left connecting assembly 162 are constructed for being slightly bowedoutwardly from axis 200 in the region of hinge 178.

Right and left connecting assemblies 160 and 162 are thus bowedoutwardly from longitudinal axis 200 in opposite directions along atransverse axis 202. This configuration, as well as the offset mountingdescribed above causes hinge regions of connecting assemblies 160 and162 to be twisted outwardly in the direction of Arrows "B" (FIG. 8) tocreate a restoring force whenever hinges 170 and 178 are locked anddevice 140 is contracted in an angular direction of Arrow "C", FIG. 7.

In operation, referring to FIG. 2, forearm 116 of arm 112 is graduallymoved by a manual massaging action from its LROM angular positiondepicted at angle α₀ to initial extended ROM angle α₁ which is selectedto be as far as forearm 116 can be extended without inflicting damage tomuscles and connective tissue between the forearm and upper arm 114.

Referring to FIGS. 4-6 and 9, with forearm 116 held in this extendedposition of α₁, bolts 184 of hinges 170 and 178 of orthotic device 140are loosened so that upper device member 144 can be fit onto upper arm116 and attached thereto by first strap 154, cuff 150 being used to padthe upper portion and protect the upper arm. In a like manner, lowermember 148 is fit onto and attached to forearm 116 by second strap 156.Hinges 170 and 178 are then locked into position by tightening bolts 184so that device 140 conforms to the ROM angle (i.e., ROM angle α₁)between individual's forearm 114 and upper arm 116. At this point,connecting assemblies 160 and 162 are unstressed and provide no forcewhatsoever on arm 112 as long as the arm is held at ROM angle α₁.

With orthotic device 140 attached to arm 112 as described above at armROM angle α₁ and with the arm held (by other than the orthotic device)and as depicted in FIGS. 5 and 6, the arm is then released and forearm116 is pulled back (in the direction of Arrow "C", FIG. 7) toward LROMangle α₀ by the previously stretched muscles and connective tissueacross elbow 142.

Connecting assemblies 160 and 162 thus function as torsion springswhich, as they are increasingly twisted outwardly by contracture of arm112, store increasing amounts of energy as forearm 116 increasinglycontracts back toward upper arm 114. At some angular return positionbetween α₁ and α₀, the restoring spring energy in connection assemblies160 and 162 and the contracture force attempting to return forearm toits LROM angle α₀ equalize and the return contracture movement offorearm 116 ceases. Thereafter, the muscle fibers and connecting tissueacross elbow 142 start relaxing or weakening, and the stored torsionalenergy in connecting assemblies take over and start to pull forearm backtoward ROM angle α₁. At some time before or as forearm 116 reaches backto angle α₁, the contractile forces on arm 112 take and once again startpulling the forearm back towards LROM angle α₀ relative to upper arm114. The cycling of forearm 116 back and forth between LROM angle α₀ andextended angle α₁, is repeated, as indicated in the time interval t₀ tot₁ depicted in FIG. 3, until the muscle fibers and connective tissueacross elbow 142 are stretched to the point that they no longer provideany contracting force at ROM angle α₁.

With device 140 remaining attached to arm 112, device hinges 170 and 172are then loosened and forearm 116 is massaged against contracture forcesuntil the forearm is stretched as far as possible without injury tomuscle fibers and connective tissue to a new ROM angle α₂. Hinges 170and 172 are retightened and forearm 116 is then released. Alternatively,when ROM angle α₁ has been attained, device 140 may be removed from arm112 and may be reinstalled after hinges 170 and 172 have been reset toROM angle α₂.

The cycling of forearm 116 between ROM angle α₂ and ROM α₁ then startsupon release of forearm 116 and continues in the above-described manneruntil the arm can stay at ROM α₂ on its own.

The above-described process is repeated through ROM angle α₃ until afull ROM angle of arm 112 is attained, for example, ROM angle α₄ at timet₄ as depicted in FIG. 3.

The alternative use of ratcheting type of hinges 170a and 172a depictedin FIG. 11 make the above-described steps of increasing the angle ofconnecting assemblies 160a and 162a easier. The ratcheting action ofhinges 170a and 172a depicted in FIG. 11 also allow progression from α₁to α₂ to occur without the need to manually adjust the hinge setting asthe limb "relaxes" or "fatigues" allowing additional extension duringthe "relaxed" phase of contraction and extension cycling.

Device connecting assemblies 160 and 162, as well as 160a and 162a, arepreferably constructed of a stiff elastomeric plastic material, such aspolyurethane or fiberglass. As with entire device 140, dimensions ofconnecting assemblies 160 and 162 are necessarily varied in dimensions,as can be determined by one skilled in the relevant art, according tothe age, size and muscular and interconnecting tissue characteristics ofthe individual to be fitted with the device and further according to theextent of LROM of the individuals arm and the duration and type ofimmobility which has caused contracture of arm 112.

It will be appreciated that the same principle of operation describedabove for device 140 is used with the below-described other types oforthotic devices which are within the scope of the present invention. Byother types it is meant types of orthotic devices that are specificallydesigned for other skeletal parts of the body--such as knee, wrist,ankle and so forth. The main differences in the various types oforthotic devices disclosed herein are the means for attaching thedevices to the body or for causing one or both of the main parts of thedevice to bear operatively against an associated part of the body.Consequently, description of the devices will be concentrated on theprincipal differences between the device being described and device 140which is described above in detail.

Knee- or Leg-Type Orthotic Device of FIG. 12

FIG. 12 depicts a knee- or leg-type orthotic device 200 in accordancewith another embodiment of the present invention. Because of thesimilarity between elbow 142 and a knee 202 it will be readilyunderstood that knee-type device 200 is virtually identical withabove-described elbow-type device 140 except for a shaped knee retainer204 that is detachably attached to connection assemblies 160a and 166a(which correspond directly to connection assemblies 160 and 166 ofdevice 140) so as to keep knee 202 from slipping through the device.

Connection assemblies 160b and 166b are attached to respective upperdevice member or portion 144a and lower member or portion 146a in thesame offset manner described above for corresponding upper and lowermembers 144 and 146 of device 140. Upper and lower members 154a and 156arespectively are detachably installed on leg 210 in the same way upperand lower members 154 and 156 are attached to arm 212, that is, theupper and lower members are attached to respective upper leg or thigh212 and lower leg 214 by respective straps 154a and 156a, and arecovered with padded cuffs 150a and 152a to protect leg 210.

In FIG. 12, leg 210 is shown in solid lines at ROM angle α₁ and inphantom lines at LROM angle α₀.

The operation of knee-type orthotic device 200 is identical to theoperation of arm-type orthotic device 140 described above and does not,therefore, require any description.

Hip Abduction-Type Orthotic Device of FIG. 13

In some contracture conditions, including hip abduction, knee abductionand scissoring of the lower limbs, and as depicted in FIG. 13, an ankleregion of one leg 220 of an individual is held in the LROM positionagainst (as indicated in phantom lines) or crossed over the ankle regionof other leg 222. This condition can understandably prevent theindividual from walking or engaging in any activity requiring the use ofan individual's legs.

In such a condition, the therapeutic objective is to restore normal ROMof legs 220 and 222 relative to one another by use of a hipabduction-type orthotic device (or knee abduction device) 224 whichcomprises a connection member 160c (similar to above-describedconnection member 160) which is connected between ankle regions ofrespective right and left ankle boots 226 and 228.

In this regard, a distal end of right portion 166c of connection member160c is attached to an rear, ankle region of right boot 226 by a pivotpin 230 and a distal end of left portion 166c of member 160c is attachedto a rear, ankle region of left boot 228 by a pivot pin 232. Proximalends of member portions 160c and 168c are interconnected by a hingeassembly 170c.

Each connection member portion 166c and 168c is shown in phantom linesin FIG. 13 at a LROM angle α₁ relative to a vertical axis or plane 234.Shown in solid lines in FIG. 13, connection member portions 166c and168c are at post-treatment ROM angles α₄ relative to vertical plane oraxis 234.

Step-wise operation of hip-type device 224 is exactly as described abovefor elbow-device 140 and knee-device 200, with connection member 160cfunctioning as a spring pulling legs 220 and 221 apart in response tocontracted muscle fibers and connective tissue at the hip joint pullingthe legs together.

Amputated Leg-Type Orthotic Device of FIGS. 14 and 15

A number of regions of the body can be afflicted by contractures butwhich are not configured in such a manner that the orthotic devices ofthe present invention cannot be configured in the manner of elbow-typeand knee-type orthotic devices 140 and 200 described above.Nevertheless, the principle of the above-described operation to overcomecontractures of these other parts of the body is essentially identicalto that described for orthotic devices 140, 200 and 224.

FIGS. 14 and 15 depict a hip or pelvic control orthotic device 250 inaccording to the present invention that is useful for the treatment ofcontracture of a remaining stump portion 252 of an individual's legafter the remaining lower portion of the leg has been amputated.

In the case being considered herein, contracture of stump 252 has causedthe stump to point upwardly or outwardly at some LROM angle. FIG. 15shows stump 252 pointing upwardly or outwardly at a LROM angle α₀relative to the individual's lower body. Not only is such a contractureof stump 252 unsightly and embarrassing to the individual, but in apractical sense makes many sitting or sleeping positions impossible oruncomfortable, makes dressing of the individual very difficult andprevents the use of an orthopedic or artificial leg impossible.

The intent of amputated leg-type orthotic device 250 is to restore, inthe manner described above relative to elbow-type orthotic device 140and knee-type device 200, the full angular ROM of stump 252 relative tothe individual's trunk 254. Such restoration will enable the individualto move stump 252, without external assistance, to and from a normal legposition relative to trunk 254 to thereby enable the individual to leada more normal life.

As shown in FIG. 14, the orthotic device 250 of the present inventioncomprises a plate or plate portion 256 and a detachable stump attachmentelement or adjustable strap 258. Plate portion 256 is formed from a flatsheet of thermal-setting plastic, such as KYDEX® or LEXAN®, and isgenerally rectangular in shape and about one-eighth of an inch inthickness. Plate or plate portion 256 is formed having a split 260 inthe thigh region along a longitudinal axis 262, the split definingside-by-side first and second thigh regions 264 and 266, respectively.

A transverse bend line 268 (which can be considered as a hinge line)isdefined between thigh regions 264 and 266 at the distal end of split260, and essentially divides the thigh regions from a seat portion 270.

Depending on which leg has been amputated, attachment element 258 isinstalled through slots 272 in either second or second thigh regions 264or 266 adjacent a proximal edge 280. As depicted in FIG. 14, attachmentelement is installed through slots 272 in second thigh region 264 foruse with stump 252 of the individual's right leg. A padded sleeve 282(FIG. 15) is preferably installed over plate 256 to provide comfort tothe individual being treated.

With the individual lying on a firm surface 280, such as a massagetable, stump 252 is massaged by another individual, who may be aphysical therapist, from its contracture LROM angular position α₀ to aninitial extended ROM angular position α₁ (FIG. 15), which corresponds tothe initial ROM angular position described above for devices 140 and200.

The individual's extended ROM angle α₁ of stump 252 is measured by agoniometer, in a well known manner. Device plate 256 is heated alongbend line 268 and first thigh region 264 is bent along the bend line toangle α₁ (FIG. 15) and is then allowed to cool to "lock" the bend atsuch angle.

With the individual's stump 252 held at ROM angle α₁, he or she islifted and device 250 is slid under the individual so that potion 270 isbeneath the patient's buttocks and so that stump 252 is resting on firstthigh region 264. Attachment element 258 is installed around stump 252and is tightened to securely hold the stump against region 264 of device250, plate region 270 being held down by the individual's weight.

When stump 252 is then released, the stretched hip muscle fibers andconnective tissue contract and pull the stump and flex second thighregion 264 back toward LROM angle α₀. As a result, thigh region 262 ofdevice plate 256 becomes temporarily flexed or elastically bent into acurve in the same manner that a limb of an archery bow is flexed andbent when the bow is drawn to shoot an arrow. As stump 252 is thuspulled back against the bending of thigh region 262 and approaches LROMangle α₀, the associated hip muscles and connecting tissue relax to anextent that energy stored in the flexed thigh region 252 of plate 256,pulls stump 252 back toward ROM angular position α₁ against therestoring forces of the hip muscle fibers and connecting tissue.

After a number of such cycles (as depicted in FIG. 3), the angular ROMof stump 252 is extended to angle α₁. At this point, device 250 isremoved from the individual and the stump is massaged to a furtherextended ROM angle α₂ and is held there while plate 256 is heated alongline 268 and is bent to new ROM angle α₂. Device 250 is reapplied to theindividual as described above and the just-described cycling procedureis repeated until the angular ROM of stump 252 has increased to angleα₂. This procedure is repeated until the full angular ROM (for example,angle α₄) is achieved.

From the foregoing description, it can be seen that device 250 isexactly analogous to devices 140 and 200 which have been describedabove. In the case of device 250, the material of plate portion 256adjacent bend line 268 deforms in operation, for example, like hinges170 and 178 described initially in connection with device 140.

Foot-Type Orthotic Device of FIG. 16

There is depicted in FIG. 16 a foot-type orthotic device 300 inaccordance with the present invention for therapeutic treatment ofinversion of the foot, and external rotation of the hip. By way ofexample, FIG. 16 depicts in phantom lines a foot 302 that as a result ofcontracture is turned inwardly(inversion).

Comprising device 300 are a boot portion 304, to a rearward region ofwhich is attached a plastic bar 308. Bar 308 may be constructed of thesame plastic material as plate 256 of stump-device 250 described aboveand has a bend line 310.

With partial boot 304 installed on an individual's foot 302 and theindividual resting on a surface, such as a bench, the floor or abed(designated by reference number 314), an end region 312 of bar 306bears against the floor, bench or bed.

Through a sequence of therapeutic foot extension steps in which bar 306is heated and bent at angles α₁ through α₄ at bend line 310, associatedwith a like sequence of increasing foot ROM angular positions fromcontracture LROM angle α₀ to fully extended ROM angle α₄, a full ROM ofthe foot is achieved in precisely the same manner described above forstump-type device 250. Accordingly, no further description of foot-typeorthotic device 300 is considered necessary.

Cervical Extension Orthotic Device of FIG. 17

A forward cervical extension orthotic device 350 depicted in FIG. 17 issimilar in general construction and operation to stump-type device 250and foot-type device 300 described above. Comprising cervical extensionorthotic device 350 is a cervical extension flexible bar or stem 352,which is preferably constructed of the same flexible plastic material asplate 256. A head-restraining member or headpiece 354 is attached to anupper end of stem 352. A lower region of stem 352 is retained inside avest-like retainer 360 that is detachably attached (as by hook and loopfasteners) around an upper body portion 362 of the individual beingtherapeutically treated by device 350.

With the individual's head 364 initially bent sharply forwardly anddownwardly at a LROM angular position α₀, due to contracture of neckmuscle fibers and connecting tissue, the head is massaged upwardly andbackwardly to ROM angular position α₁ and is held in that position.

After the head angle α₁ has been measured (for example, by agoniometer), device stem 352 is heated along a transverse bend line 366to a matching angle. A lower end region of stem 352 is then inserteddownwardly into an upper region 368 of retainer 362. Headpiece 354 isdetachably attached by a strap 370 around head 364 and the head isreleased.

As described below, for example, relative to stump-type device 250(FIGS. 14 and 15), head 364 is released and is pulled by contractedmuscle fibers and connective tissue back toward LROM angle α₀, therebyflexing stem 352, which then pulls the head back towards angle α₁₋₋ allin the manner described above. This cycle is repeated until the head'sROM has been extended to ROM angle α₁.

Headpiece 354 is then detached from head 364 and device 350 is detachedfrom the individual. Head 364 is then massaged to angular position α₂and is held there while stem 362 is reheated and rebent at bend line 366to a matching angle, at which time device 350 is reinstalled on theindividual as depicted in FIG. 17. When head ROM position α₂ has beenestablished in the manner for ROM angular position α₁ p, the operationis repeated as many times as is required to fully extend the ROM of head364, for example, at ROM angle α₄.

Back-Type Orthotic Device of FIG. 18

There is shown in FIG. 18 a back-type orthotic device 400 according tothe present invention which is useful for extending the ROM of anindividual's back which is involuntarily restricted by contracture ofback muscle fibers and connective tissue to an LROM which misshapes theindividual's back, for example, into a general S-shape.

Comprising orthotic device 400 are a generally I-shaped flexible plate402 (which is preferably constructed of the same material as plate 256of stump-type orthotic device 250) and a harness assembly 404 which isworn around the upper torso 406 for detachably attaching the back plateto the individual's back in the region of contracture. A transverse bendline 408, which functions as a lockable hinge, separates plate 402 intorespective upper and lower portions 410 and 412.

Back plate 400 functions and is operated in conjunction with theindividual's back in the same manner that stump device plate 256 anddevice stem 352 of cervical extension orthotic device 350 as the ROM ofthe individual's back is increased from an initial LROM angle α₀ to afully extended (that is, straightened) ROM angle, for example angle α₄.In the above-described manner, for example, for orthotic device 350.During such procedure, back plate 402 is heated and bent along bend line408 at each increased ROM angle of the individual's back (for example,at ROM angles α₁, α₂, α₃ and α₄. In each case, the flexing of plate 402about bend line 408 working against contracture forces of theindividual's back causing a cycling between angles α₀ and α₁, between α₁and α₂ and so forth in the manner described above until the full ROM ofthe back I attained.

Upper Torso-Type Orthotic Device of FIG. 19

There is shown in FIG. 19 an upper torso-type orthotic device 450 inaccordance with the present invention for treating sideways or forwardcontracture of an individual's upper torso relative to the individual'slower torso, and for restoring the full side-to-side andforward-to-straight ROM of the upper torso.

Comprising device 450 are a member 452, which is preferably constructedof the same flexible plastic material as, for example, plate 256described above, and strap means 454 for detachably attaching the memberto an individual's upper torso and thighs, as depicted in FIG. 19 and asdescribed below.

Member 452 is formed in one piece of right and left side L-shaped sideportions 456 and 458, respectively, which fit vertically along theindividual's right and left sides and horizontally along the seatedindividual's respective right and left thighs 460 and 462. Furthercomprising member 452 is an arcuate portion 464 which interconnectsupper end regions of side portions 456 and 458, and which fits aroundforward regions of the individual's upper torso. Member 452 ispreferably padded to provide comfort to the individual.

Vertical sections or regions of side portions 456 and 458 function inthe manner of stem 352 of orthotic device 350, as described above inconnection with FIG. 17. In that regard, each of the vertical sectionsof side portions 456 and 458 have transverse bend lines 470 and 472,respectively, which divide the vertical sections into upper and lowerregions and which function in the manner of lockable hingesinterconnecting such upper and lower regions.

In the manner described above, for example, in conjunction withstump-type orthotic device 250 (FIGS. 14 and 15)and cervical extensionorthotic device 350 (FIG. 17), the individual's upper torso is workedfrom an initial LROM angular position α₀ caused by contracture, throughincreasing greater ROM angular positions α₁, α₂ and α₃ until the fullROM angular position α₄ is reached (it is, of course to be understoodthat more or fewer than the four ROM angular positions α₁, α₂, α₃ and α₄may, in practice, be required).

Further in the manner described above relative to orthotic devices 250,300, 350 and 400, these ROM angular positions α₁, α₂, α₃ and α₄ of theindividual's torso are provided by sequentially bending verticalsections of side portions 456 and 458 about respective bend lines 470and 472 at angles α₁, α₂, α₃ and α₄, the side sections being elasticallybent at each ROM angular position by contractive forces of the torsopulling the torso back toward the previous ROM angular position.

Ankle-Type Orthotic Device of FIG. 20:

There is depicted in FIG. 20 an ankle-type orthotic device 500 furtherin accordance with the present invention, that is configured fortreating contracture of an individual's foot 502 relative to theindividual's lower leg 504, about the ankle 506. The particular type ofcontracture depicted is such that foot 502 is straightened out or is ina "foot-dropped" condition, with its LROM angular position at α₀. Othertypes of contracture of foot 502 are possible and are therapeuticallytreated in a manner similar to that described hereinbelow for thedropped-foot condition.

Device 500 comprises a single piece slipper-shaped flexible plasticmember 508 which has sole and ankle regions 510 and 512, respectively.Preferably, a cutout 514 is provided in member 508 at heel 506 toeliminate pressure on the heel. A transverse bend line is located alonga transverse axis 516 through cutout 514. A soft inner padding 518 isprovided which wraps about foot in a protective manner. Included inorthotic device 500 is a detachable strap 520 for holding the device 500onto foot 502.

Right and left side adjustable side straps 522 and 524, respectively,are connected to an upper end of ankle region 512 by a back-strap 526and extend under sole region 510 for enabling alignment of foot 502 asmay be necessary.

Member 508, which is constructed from a flexible, thermal-settingplastic, is successively bent around bend axis 516 at angles α₁, α₂, α₃and α₄ to extend the angular ROM of foot 502 from its LROM position ofα₁ to its full ROM of α₄ in the same manner described above for orthoticdevices 250, 300, 350, 400 and 450. Consequently, a further detaileddescription of orthotic device 500 is not considered to be necessary,except to note that single piece member 598 may alternatively beconstructed of two separate sections corresponding to sections 510 and512 which are interconnected with interconnection members similar toabove-described members 160 and 162 of orthotic device 140 (FIGS. 5-8).

Wrist-Type Orthotic Device of FIGS. 21 and 22

There is shown in FIGS. 21 and 22 a wrist-type orthotic device 550 inaccordance with the present invention for treating one or more types ofcontracture afflicting an individual's hand 552 relative to forearm 554about a wrist 556. Shown comprising orthotic device 550 are an elongate,flexible plastic member 558 which is fashioned to fit the inner surfaceshape of an individual's lower forearm 554, wrist 556 and palm of his orher hand 552. Included in device 550 are adjustable straps: forearmstrap 560, wrist strap 562 and hand strap 564.

It can be understood that a healthy individual can rotate his or herhand 552 through a complete circle relative to forearm 554 about wristconnection or joint 556. For orthotic device 550, member 558 is shapedand bent at any appropriate bend or torsion line, for example,transverse bend line 568 (FIG. 21), to treat different variouscontractures affecting hand 552 with respect to forearm 554.

Consequently, applied to present orthotic device 500 for treatingcontractures of hand 502 is the same method described above with respectto orthotic devices 250, 300, 350, 400 and 450, including bending theassociated flexible plastic members 256, 310, 352, 402, 452 inincremental, progressive angular steps to increase the ROM of anaffected body part from its LROM of α₀, through intermediate ROM anglesα₁, α₂ and α₃, to the fully extended ROM angle α₄.

Shown also in FIGS. 21 and 22 with respect to orthotic device 500 aremeans 570 for treating contracture of fingers 570, 572, 574 and 576 bymeans of a flexible cylinder 580, as more particularly described withrespect to the following head-type orthotic device.

Head Hyperextension-Type Orthotic Device of FIGS. 23 and 24

Shown in FIGS. 23 and 24 is a hyperextension-type orthotic device 600,in still further accordance with the present invention, for treating acontracture of neck muscular fibers and connecting tissue which causesan individual's head 602 to be involuntarily held in an extremehead-back LROM angular position α₀ (FIG. 23).

Comprising orthotic device 600 is a slightly curved stiff bar 604, alower end region of which is retained in a block 606 that is detachablyheld to the individual's back by adjustable straps 608 and 610. Furthercomprising orthotic device 600 is a series of elastic cylinders or neckbolsters 620, 622, 624 and 626 (FIG. 24 and shown in phantom line inFIG. 23). These bolsters 620, 622, 624 and 626 have respective diameterswhich correspond to progressively greater ROM angles α₁, α₂, α₃ and α₄,and when are sequentially installed between bar 604 and a back region630 of the individual's head cause the head to be moved to correspondingROM angular positions α₁, α₂, α₃ and α₄ from contracture LROM positionα₀, to ROM angular positions α₁, α₂, α₃ and α₄ in the same manner thatwould occur if bar 504 were to be progressively bent to such ROM angles(in the manner described above for orthotic devices 250, 300, 350, 400,450, 500 and 550).

This principle of using cylinders or bolsters of increasing diameters isused as well to treat contracture of an individual's fingers 570, 572,574 and 576 for orthotic device 550 (FIGS. 21 and 22).

Shoulder- and Arm-Type Orthotic Device of FIGS. 25 and 26

There is shown in FIGS. 25 and 26 a shoulder-and arm-type orthoticdevice 650, in accordance with the present invention, whish is used totreat contracture of an individual's arm 652 relative to theindividual's shoulder 654 (FIG. 26). Shown comprising orthotic device650 are a flexible pillow body 656 having an internal recess or pocket658 for receiving one of graduated flexible plastic elements 660, 662,664 and 666 which are sized and or otherwise constructed (for example,of increasingly denser or stiffer materials) to correspond toprogressively greater ROM angles α₁, α₂, α₃ and α₄ of arm 652 relativeto shoulder 654.

In operation, after arm 652 has been extended from LROM angle α₀relative to shoulder 654, by manual massage and slow extension, to ROMangular position α₁, and the arm is held in that angular position,elastic element 660 (which corresponds to ROM angle α₁) is inserted intopocket 658. Thereafter, body 656 (which is constructed of a pliablematerial, such as nylon fabric) of orthotic device 650 is detachablyattached to under regions of arm 652, in the individual's armpit, byadjustable straps 666, 668 and 670, with a body flap 672 abutting theindividual's body (FIG. 26). In this case, the intersection line 674between body 656 and flap 672 functions as a hinge and element 660functions as a hinge lock.

In such attachment of orthotic device 650, elastic element 660 functionsas a spring which is unloaded at ROM angle α₁. When the individual's arm652 is then released, the contracture of muscle fibers and connectingtissue in the armpit region pulls the arm back toward LROM angularposition α₀, thereby compressing element 660.

This compression of element 660 counteracts the contracture and, whenthe muscle fibers and connective tissue relax or fatigue, pushes arm 652back away from the individual's body toward ROM angular position α₁.After several or a number of such contraction and extension cycles, arm652 achieves the extended ROM of α₁.

The foregoing procedure is repeated, using elastic elements 662, 664 and666 (through intermediate ROM angular positions α₂ and α₃) until arm 652reaches its fully extended ROM angular position α₄.

From the foregoing description, it will be appreciated that orthoticdevice 650 functions in the same manner, for example, as elbow-typeorthotic device 140 (Ref. FIGS. 5-11) and knee-type orthotic device 200(Ref. FIG. 12) described above, with elastic elements 660, 662, 664 and664 taking the place of spring-type connecting members 160 and 162 (fordevice 140) and 160b and 162b (for device 200). In fact, orthotic device650 can be modified in an obvious manner to serve as orthotic devicesfor treating contracture of the elbow and contracture of the knee.

It is to be understood that although for descriptive purposes, extensionof a skeletal body part, such as a forearm, foot, lower leg, head, hand,and the like has been described in terms of extension to a extendedrange of motion (EROM) from an initial limited range of motion (LROM)angle α₀ to an extended angle α₄ through intermediate ROM angularpositions α₁, α₂ and α₃, it is to be understood that no limitation isintended or implied thereby. In actual practice, a greater or lessernumber of intermediate ROM angles may be required. Moreover, the numberof degrees between each adjacent pair of ROM angular positions willusually not be equal.

It is also to be understood that although several differentconfigurations of orthotic devices have been described, all functionaccording to the same principle--that of the contracture forces loadinga spring to thereby cause a return to an extended ROM.

Although there has been described and illustrated various types oforthotic devices utilizing the same principle for treating contracturesof various parts of a human body in accordance with the presentinvention for purposes of illustrating the manner in which the inventionmay be used to advantage, it is to be appreciated that the invention isnot limited thereto. Therefore, any and all variations and modificationsthat may occur to those skilled in the applicable art are to beconsidered as being within the scope and spirit of the claims asappended hereto.

What is claimed is:
 1. An orthotic device useful for extending the rangeof angular movement between adjacent first and second skeletal bodyparts which have been drawn to and involuntarily held in limited angularrange of motion (LROM) angular position relative to one another bycontraction of muscle fibers and connective tissue due to immobility ofone or both of said skeletal body parts, said orthotic devicecomprising:a. a thermal setting, flexible member having first and secondregions; b. a bend line between said first and second member regions, abend at said bend line being set by heating, bending and cooling saidmember at said bend line, said bend line permitting angular movementbetween the first and second regions and enabling the setting of aselected angle between said first and second member regions; c. meansfor applying or attaching said first member region to the first bodypart and said second member region to the second body part after thesecond body part has been moved against contracture forces away fromsaid LROM position to an initial extended range of motion EROM angularposition relative to the first body part, said first and second memberregions being then set at said initial EROM position relative to oneanother; and d. spring means associated with the first and second memberregions for urging the second member region and the attached or appliedsecond body part to return to said EROM position in response to thesecond member region being pulled by the applied or attached firstmember region through muscle fiber contraction and the elasticproperties of the muscle fibers and connective tissue away from saidEROM position and toward said LROM position, thereby causing a cyclingmovement of the second body part between said EROM and LROM angularpositions and a gradual loosening of said second body part relative tosaid first body part and an ultimate extending of the range of motion ofthe second body part relative to the first body part at said EROMposition without additional external intervention.
 2. The orthoticdevice as claimed in claim 1, wherein said spring means are configuredfor providing substantially no spring force between said first andsecond member regions when the second member region is at said initialEROM angular position relative to the first member region.
 3. Theorthotic device as claimed in claim 1, wherein said first body partcomprises the individual's forearm at the wrist and wherein said secondbody part comprises said individual's hand.
 4. The orthotic device asclaimed in claim 1, wherein said first body part comprises theindividual's lower leg at the ankle and wherein said second body partcomprises said individual's foot.
 5. The orthotic device as claimed inclaim 1, wherein said spring means is provided by flexibility of saidmember.
 6. The orthotic device as claimed in claim 1, wherein saidmember is constructed from a plastic material.
 7. An orthotic deviceuseful for extending the range of angular movement between adjacentfirst and second skeletal body parts which have been drawn to andinvoluntarily held in an limited angular range of motion (LROM) positionrelative to one another by contraction of body muscle fibers andconnective tissue due to immobility of one or both of said skeletal bodyparts, said orthotic device comprising:a. a thermal setting, flexibleplastic member having second and second member regions; b. a bend linebetween said first and second member regions, a predetermined bend atsaid bend line being set by heating, bending and cooling said member atsaid bend line, said bend line permitting angular movement and enablingthe setting of a selected angle between said first and second memberregions; c. means for applying or attaching said first member region tothe first body part and said second member region to the second bodypart after the second body part has been moved against contractureforces away from said LROM position to an extended range of motion(EROM) angular position relative to the second body part, said first andsecond member regions being then set at said EROM angular positionrelative to one another; and d. spring means associated with the firstand second member regions for urging the second member region and theattached or applied second body part to return to said EROM position inresponse to the second member region being pulled by the second memberregion and the applied or attached first body part through muscle fibercontraction and/or the elastic properties of the muscle fibers andconnective tissue away from said EROM position and toward said LROMposition, thereby causing a cycling movement of the second member regionand the second body part between said EROM and LROM angular positionsand a gradual loosening of said second body part relative to said firstbody part and an ultimate extending of the range of motion of the secondbody part relative to the first body part at said EROM position withoutadditional external intervention, said spring means being provided byflexibility of said member and said spring means being configured forproviding substantially no spring force between said first and secondmember regions when the second member region is at said EROM angularposition relative to the first member region.
 8. The orthotic device asclaimed in claim 7, wherein said first body part comprises theindividual's forearm at the wrist and wherein said second body partcomprises said individual's hand.
 9. The orthotic device as claimed inclaim 7, wherein said first body part comprises the individual's lowerleg at the ankle and wherein said second body part comprises saidindividual's foot.